Healthcare Provider Details

I. General information

NPI: 1336670603
Provider Name (Legal Business Name): SUSAN ANSLEY SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD STE 502
LEXINGTON KY
40503-1487
US

IV. Provider business mailing address

1720 NICHOLASVILLE RD STE 502
LEXINGTON KY
40503-1487
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-7129
  • Fax: 859-277-9613
Mailing address:
  • Phone: 859-277-7129
  • Fax: 859-277-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number59400
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: